Angiosome-based perfusion monitoring system

ABSTRACT

A compression device includes at least one pressurizable bladder to substantially occlude blood flow into skin capillary beds adjacent to the at least one pressurizable bladder, and a plurality of perfusion sensors. In operation a first-angiosome sensor detects the perfusion parameter of a skin capillary bed in a first angiosome of the limb, and a second-angiosome sensor detects the perfusion parameter of a skin capillary bed in a second angiosome of the limb that is different from the first angiosome. A control circuit maps sensor signals from the first-angiosome sensor to the first angiosome or a first artery of the limb, and maps sensor signals from the second-angiosome sensor to the second angiosome or a second artery of the limb different from the first artery of the limb. For each perfusion sensor, the control circuit determines whether the received sensor signals are indicative of peripheral artery disease.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional ApplicationSer. No. 61/668,479, filed Jul. 6, 2012, the entirety of which is herebyincorporated by reference.

FIELD OF THE DISCLOSURE

The present invention generally relates to an angiosome-based monitoringsystem.

BACKGROUND

In 1987, Taylor and Palmer introduced the angiosome concept, in whichthe body is considered to consist of three-dimensional blocks of tissuesupplied by particular source arteries. FIG. 9 is a schematic, anteriordiagram of the lower body depicting angiosomes, and FIG. 10schematically illustrates the source arteries associated with theangiosomes in FIG. 9. The source arteries associated with respectiveangiosomes include the deep circumflex iliac artery (101), commonfemoral artery (102), lateral circumflex femoral artery (103),superficial femoral artery (104), medial circumflex femoral artery(105), and descending genicular artery (106). FIG. 11 is a schematic,posterior diagram of the lower body depicting angiosomes, and FIG. 12schematically illustrates the source arteries associated with theangiosomes in FIG. 11. The source arteries associated with respectiveangiosomes include the lumbar artery (107), superior gluteal artery(108), inferior gluteal artery (109), internal pudendal artery (110),deep femoral artery (111), popliteal artery (112), posterior tibialartery (113), peroneal artery (114), anterior tibial artery (115),lateral plantar artery (116), medial plantar artery (117), and suralartery (118).

SUMMARY

In one aspect a compression device is sized and shaped for placement ona limb of a subject. The compression device includes at least onepressurizable bladder configured to exert a suitable compressive forceon the limb of the subject when pressurized to substantially occludeblood flow into skin capillary beds adjacent to the at least onepressurizable bladder, and a plurality of perfusion sensors. Inoperation at least one sensor of the plurality of perfusion sensors is afirst-angiosome sensor for detecting the perfusion parameter of a skincapillary bed in a first angiosome of the limb, and at least one sensorof the plurality of perfusion sensors is a second-angiosome sensor fordetecting the perfusion parameter of a skin capillary bed in a secondangiosome of the limb that is different from the first angiosome. Acontrol circuit receives separate sensor signals from the plurality ofperfusion sensors on the compression device during depressurization ofthe at least one bladder, wherein the sensor signals are indicative ofperfusion parameters of skin capillary beds adjacent the perfusionsensors for quantifying skin capillary bed perfusion. The controlcircuit maps sensor signals from the first-angiosome sensor to at leastone of the first angiosome and a first artery of the limb, and mapssensor signals from the second-angiosome sensor to at least one of thesecond angiosome and a second artery of the limb different from thefirst artery of the limb. For each perfusion sensor, the control circuitdetermines whether the received sensor signals are indicative ofperipheral artery disease.

Other objects and features will be in part apparent and in part pointedout hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of one embodiment of anangiosome-based perfusion monitoring system, the monitoring systemincluding a compression device and a control device;

FIG. 2 is an inner side view of the compression device of FIG. 1,including markings to indicated groupings of perfusion sensors accordingto angiosomes of the leg;

FIG. 3 is a diagram of the angiosome-based perfusion monitoring system,including electrical and fluid communications between componentsthereof;

FIG. 4 is an exemplary, schematic screen shot of a graphical userinterface during a first mode of operation of the monitoring system;

FIGS. 5-7 are an exemplary, schematic screen shots of a graphical userinterface during a second mode of operation of the monitoring system,the graphical user interface depicting the revascularization of the leg;

FIG. 8 is an exemplary graph depicting perfusion data collected by thecontrol device;

FIG. 9 is a schematic, anterior diagram of the lower body depictingangiosomes;

FIG. 10 schematically illustrates the source arteries associated withthe angiosomes in FIG. 9;

FIG. 11 is a schematic, posterior diagram of the lower body depictingangiosomes; and

FIG. 12 schematically illustrates the source arteries associated withthe angiosomes in FIG. 11.

Corresponding reference characters indicate corresponding partsthroughout the drawings.

DETAILED DESCRIPTION OF THE DRAWINGS

Referring to FIGS. 1-3, an angiosome-based perfusion monitoring systemfor treating and/or diagnosing peripheral artery disease is indicatedgenerally at reference numeral 10. The angiosome-based perfusionmonitoring system 10 includes a compression device, generally indicatedat 12, and a control device, generally indicated at 14. The illustratedcompression device 12 is configured to be disposed around a leg of awearer. In particular, the illustrated compression device 12 isconfigured to be wrapped around the leg of the wearer and extendlongitudinally from the wearer's thigh toward the wearer's ankle (e.g.,including the calf), although the compression device may be configuredto be wrapped around only a portion of the wearer's leg (e.g., thewearer's calf). The compression device 12 includes one or moreinflatable bladders, and in the illustrated embodiment, the compressiondevice includes three longitudinally-spaced bladders: a thigh bladder 15a, a calf bladder 15 b, and an ankle bladder 15 c. Each bladder 15 a, 15b, 15 c is sized and shaped for wrapping around a substantially fullcircumference of the wearer's leg, although the bladders may beconfigured to wrap partially around the circumference of the wearer'sleg. It is understood that in other embodiments the compressive device12 may include a single bladder or any number of bladders. It is alsounderstood that in other embodiments the compression device may beconfigured to be wrapped around other parts of the wearer's body,including but not limited to one or more toes, one or more fingers, oneor more feet, one or more hands, and one or more arms.

The compression device 12 includes fasteners 16 (e.g., hook and loopfasteners) for securing the compression device to the wearer's leg. Forexample, in the illustrated embodiment, the fasteners 16 comprise maleor hook fasteners that are secured to the inner side of securement flaps18 of the compression sleeve. The compression sleeve 12 is wrappedaround the wearer's leg such that the back side (i.e., posterior side)of the leg is laid on the inner side of the compression sleeve. Theright flaps (as taken from the viewpoint of FIG. 1) are wrapped over thefront side (i.e., anterior side) of the wearer's leg, and then the leftflaps are wrapped over the right flaps and the hook fasteners 16 aresecured to female or loop fasteners on the outer surface of thecompression sleeve. The compression device 12 may comprise a pair ofopposing, sheets of generally fluid-impermeable material. These sheetsmay be heat welded together to form the bladders 15 a, 15 b, 15 c. Also,in one embodiment the compression device 12 may be radiolucent to allowfor angiographic procedures. In general, the compression device 12 maybe substantially similar to inflatable compression sleeves used inprevention of deep vein thrombosis.

Referring to FIG. 1, each of the bladders 15 a, 15 b, 15 c is fluidlyconnected to the control device 14 via flexible tubing 20 (e.g., threetubes) for selectively inflating the bladders to a selected pressure anddeflating the bladders. The control device 14 includes a fluidcompressor 22, located inside a housing 24 of the control device, fordelivering pressurized fluid (e.g., air) to the bladders 15 a, 15 b, 15c. A control circuit 26 in the control device housing 24 is programmedto control the inflation and deflation of the bladder 15 a, 15 b, 15 c.For example, the control circuit 26 may be in electrical communicationwith the fluid compressor 22 and/or valves 25 (e.g., solenoids) in thecontrol device housing 14 for regulating introduction of pressurizedfluid from the fluid compressor into the tubing 20. The control circuit26 is also in electrical communication with one or more pressure sensors27 (FIG. 3) that detect or indicate the pressure in the bladders 15 a,15 b, 15 c and communicate such information to the control circuit. Forreasons explained in more detail below, in one embodiment the controlcircuit 26 is programmed (broadly, “configured”) to pressurize (e.g.,inflate) the bladders 15 a, 15 b, 15 c to pressures from about 3 psi toabout 5 psi for a predetermined amount of time to substantially occludeblood flow into skin capillary beds of the leg adjacent the bladderswhen the compression device 12 is donned by a wearer (e.g., a patient).

Referring still to FIGS. 1 and 2, the compression device 12 alsoincludes a plurality of perfusion sensors 30 for use in detecting themicrocirculatory flow of blood (or perfusion) within skin capillary bedsof the leg. In one non-limiting example, the perfusion sensors 30comprise pulse oximetry sensors, which illuminate the skin and measurechanges in light absorption, the function of which for detectingmicrocirculatory flow of blood is generally known in the art. Theperfusion sensors 30 may be of other types for use in detectingmicrocirculatory flow. For example, other ways of measuringmicrocirculatory flow include ultra-sound; optical plethysmography;sound, e.g. a microphone for pulsatile flow in the macrocirculation;metabolic indicators such as pCO2 or lactate; and bioimpedance.

In the illustrated embodiment, the perfusion sensors 30 are securedadjacent to the inner side of the compression device 12. The sensors 30are arranged in rows extending across each of the bladders 15 a, 15 b,15 c, although it is understood that the sensors may be in otherarrangements. Each row includes a plurality of spaced apart sensors 30that are electrically connected to the control device 12 via one or morecables or wires 36 leading to the control device 14. The sensors 30 sendindividual sensor signals to the control circuit 26, each sensor signalbeing indicative of the microcirculatory flow of blood (or perfusion)within skin capillary beds of the leg. The sensors 30 are located on thecompression device 12 such that each sensor measures themicrocirculatory flow of blood (or perfusion) in skin capillary bedswithin one or more angiosomes of the leg. As explained in more detailbelow, the control circuit 26 is programmed to map or relate the signalfrom each sensor 30 to the artery of the leg that corresponds to theangiosome being monitored by the sensor. The number of sensors 30 on thecompression device 12 may vary, although it is preferred (though notmandatory) that each identified angiosome is monitored by at least onesensor. In the illustrated embodiment, each identified angiosome ismonitored by a plurality of sensors 30. Moreover, the illustratedcompression device 12 is suitable for use on a right leg of a patient.It is envisioned that the compression device 12 would be limb specific.However, a universal compression device operable on either leg fallswithin the scope of the present invention.

In one mode of operation (e.g., a diagnostic mode), the control device14 is configured to not only determine if there is possible arterialstenosis in the leg being diagnosed, but also identify the artery thatis likely occluded. In one example, the control circuit 26 is programmedto inflate (i.e., pressurize) the bladders 15 a, 15 b, 15 c to asuitable pressure (e.g., 4 psi) for a predetermined amount of time(e.g., 10-20 seconds) to substantially occlude the flow of blood intothe capillary beds in the skin of the leg adjacent the bladders. Forexample, the control circuit 26 may activate the compressor 22 and openthe valves 25 to allow pressurized air to flow into the bladders 15 a,15 b, 15 c. The control circuit 26 receives pressure signals frompressure sensors (not shown) near the valves 25, which are indicative ofthe pressure in the respective bladders 15 a, 15 b, 15 c. When apredetermined, threshold pressure has been reached, the control circuit26 may actuate closing of the valves 25 to maintain the pressure in thebladders 15 a, 15 b, 15 c. In another embodiment, the control circuit 26may receive sensor signals from the sensors 30 as the bladders 15 a, 15b, 15 c are being pressurized. In such an embodiment, the controlcircuit 26 may be programmed to pressurize the bladders 15 a, 15 b, 15 cuntil the microcirculatory flow in the capillary beds has reached athreshold value, which indicates that the bladder is occluding bloodflow to the capillary beds.

After (or before) pressurizing the bladders 15 a, 15 b, 15 c to thesuitable pressure for the predetermined amount of time, the controlcircuit 26 receives sensor signals from the perfusion sensors 30. Whilereceiving these signals from the perfusion sensors 30, the controlcircuit 26 opens the valves to slowly depressurize (e.g., deflate) thebladders at a controlled rate (e.g., 5 mmHg/s). During depressurization,the control circuit 26 receives the sensor signals from the perfusionsensors 30. Exemplary data that may be provided by each of the sensorsignals is depicted in FIG. 8 as a graph. Referring to this graph, thesensor signals received from each of the perfusion sensors 30 during(and before) depressurization are indicative of one or more of adequateperfusion 35, no flow 36, baseline flow 37, skin perfusion pressure(SPP) value 38, and return of normal microcirculation 39. Note thatpoint 35 illustrates the condition just before pressure is applied. Thisexemplary data is provided in U.S. Pat. No. 7,736,311.

The control circuit 26 is programmed to analyze the sensor signalreceived from each sensor 30 to determine whether there is possiblearterial stenosis in the leg being diagnosed. For example, the controlcircuit 26 may be programmed to determine a possible arterial blockageif the control circuit determines that the skin perfusion pressure (SPP)is below some predetermined threshold value (e.g., 1%). The controlcircuit 26, alternatively or additionally, may be configured (e.g.,programmed) to determine a possible arterial blockage if the controlcircuit determines that the time elapsed between baseline flow (or someother reference point) and return of normal microcirculation was greaterthan a threshold value. The control circuit 26 may be programmed todetermine a possible arterial blockage in other ways using the sensorsignals from each sensor 30.

As set forth above, the control circuit 26 is programmed to map orrelate the signal from each sensor 30 to an artery of the leg thatcorresponds to the angiosome being monitored by the particular sensor.In general, the location of the sensor 30 on the compression device 12will determine the angiosome to which the sensor is monitoring, which inturn, relates to a particular artery. This determination is made basedon anatomy and the projected location of the sensor 30 on the leg whenthe compression device 12 is donned. In one embodiment, the axialposition of each sensor 30 along a given row of perfusion sensors canhelp determine the location of a possible stenosis along the length ofthe associated artery. For example, in the illustrated embodiment (FIG.2) the sensors 30 are grouped into 7 groups (groups A1-A7) based on therespective angiosomes being monitored. Thus, the sensors 30 in group 1are sensing capillary beds relating to the same angiosome A1, thesensors in group 2 are sensing capillary beds relating to the sameangiosome A2 that is different than angiosome A1, and so on. AlthoughFIGS. 1 and 2 do not depict precise groupings of the sensors 30, ingeneral the sensors 30 in groups A1, A4 and A7 relate to the angiosomethat is supplied blood by the femerol artery; the sensors in groups A2,A5, and A8 relate to the angiosome that is supplied blood by theprofunda artery; and the sensors in groups A3, A6 and A9 relate to theangiosome that is supplied by the popliteal artery. In otherembodiments, additional groups may relate to the angiosomes that aresupplied by the respective anterior tibial artery, the posterior tibialartery, and the peroneal artery.

In one embodiment, the control circuit 26 may determine the artery ofthe leg that corresponds to each sensor 30 based on information providedby the sensor in the sensor signal. As an example, each sensor 30 mayconfigured to send an identifier signal (e.g., within the sensor signal)that identifies the angiosome or location on the compression sleeve thatcorresponds to the sensor. In another example, the identifier signal mayidentify the sensor 30, and the control circuit 26 may be programmed todetermine the location of the sensor based on the sensor identifier. Thecontrol circuit 26 may be capable of mapping the each sensor 30 to oneor more angiosomes in other ways without departing from the scope of thepresent invention.

In general, by mapping each sensor 30 to a particular artery, based onthe locations of angiosomes, the control circuit 26 is programmed toidentify the artery that is likely occluded (partially or totally) andcausing a measured, decreased skin perfusion. In this way, the perfusionmonitoring system 10 provides diagnosis of peripheral artery disease,including identification of particular arteries that are occluded(partially or totally) and causing the decreased skin perfusion, withoutusing medical imaging to produce an angiogram. In particular, if thecontrol circuit 26 determines that a sensor signal from a particularsensor 30 is indicative of possible peripheral artery disease, thecontrol circuit 26 then identifies the artery that supplies blood to theangiosome (or area) that is being monitored by the particular sensor. Inone embodiment, when the control circuit 26 identifies an artery thatpotentially has an occlusion (partial or total), this information iscommunicated to the practitioner (or user) via a graphical userinterface on a user interface display (e.g., LCD and/or touch screen) 40of the control device 14. In one non-limiting example, the controlcircuit may 26 be programmed to generate the name of the artery thatpossibly has a blockage on the user interface display 40. In anothernon-limiting example, the control circuit 26 may be programmed togenerate a graphical rendering of the leg (or other body portion),including the main arteries, and identify the location of the arterythat is possibly occluded (including the name of the artery) and/oridentify the location of the angiosome corresponding to the location ofthe sensor 30 from which the data used to make the assessment originated(including the name of the angiosome). Identification of the location ofthe sensor 30, relative to the compression device 12, from which thedata used to make the assessment originated may also be generated on theuser interface display 40. In another non-limiting example, the controlcircuit 26 may be programmed to also communicate to the user the artery(or arteries) and/or angiosome (or angiosomes) that were not determinedto have possible blockage. The user interface 40 for communicating thediagnosis may be separate from a user interface for controllingoperation of the control device 14, or the user interfaces may be thesame.

Referring to FIGS. 5-7, in another mode of operation (i.e., a treatmentmonitoring mode) the perfusion monitoring system 10 may be used duringrevascularization procedure to monitor the progress of revascularizingone or more regions of the leg or other body part. This process issimilar to process of diagnosing peripheral artery disease andidentifying one or more arteries that may have blockage, except that thecontrol circuit 26 does not necessarily map the sensors 30 to specificangiosomes and/or arteries to communicate the artery (or arteries) thatare potentially blocked. Instead, the control circuit 26 maps thesensors 30 to areas of the legs and generates a graphic representationof the leg to indicate areas of the leg that have adequate perfusion andareas of the leg that do not have adequate perfusion. For example, inFIGS. 5-7 the arrows indicate adequate perfusion, while the X's indicateless than adequate perfusion, although other ways of communicating suchinformation is within the scope of the present invention. It isenvisioned that in this mode of operation, the practitioner (or user) isaware of the location of the blockage site and is actively treating theblockage, such as by an atherectomy procedure, while monitoringrevascularization on the user interface display 40. Thus, in this modethe perfusion monitoring system 10 provides the practitioner with ameans to determine when revascularization (or increasedrevascularization) has occurred (FIG. 7), and thus, determine when/iftreatment is successful.

In one embodiment, the perfusion monitoring system 10 is capable ofoperating in both of the above described modes (e.g., a diagnostic modeand a treatment monitoring mode), although it may have only one mode orother modes. In one example, the perfusion monitoring system 10 includesan input 50 (e.g., a button or an icon on a touch screen user interfacedisplay 40) to allow the user to select between at least the diagnosticmode and the treatment mode. It is also envisioned that during operationof the perfusion monitoring system 10, the control circuit 26 isprogrammed to generate additional graphical user interfaces on the userinterface display 40. For example, the control circuit 26 may beprogrammed to generate the graph shown in FIG. 8 on the user interfacedisplay 40. The control circuit 26 may be configured to generateadditional user graphical user interfaces on the user interface display40. In one example (FIG. 1), an input 45 (e.g., a button or icon on atouch screen user interface display 40) on the perfusion monitoringsystem 10 allows the user to selectively switch between graphical userinterfaces on the interface display.

The perfusion monitoring system 10 is advantageous in monitoringperipheral artery disease. If the device is used during a PADintervention, progress of the treatment can be monitored independentlyof a standard angiogram. This will reduce the amount of radiationclinicians and patients are subjected to, as well as reducing the amountof contrast media which must be administered to the patient. Thereduction of contrast media is beneficial, especially for those patientswho are renally compromised such as diabetics. It may be possible toobjectively measure procedural success using the device, rather thanrelying on a subjective angiogram as a measure of success. This mayresult in shorter procedure times by preventing a clinician fromunnecessarily over treating a patient such as during an atherectomytreatment by removing plaque burden that does not contribute to diseasesymptoms, or by preventing the treatment of lesions that are notcontributing to disease symptoms. Another benefit of using the deviceduring an interventional procedure is that it would be possible todetect embolic events, again independently of angiography. The devicemay be able to detect embolic events that are not detected byangiography by detecting skin perfusion changes caused by arteries thatare too small to be noticed on an angiogram, or were not perfused wellenough on the initial angiogram to be detected by the clinician.

When introducing elements of the present invention or the preferredembodiments(s) thereof, the articles “a”, “an”, “the” and “said” areintended to mean that there are one or more of the elements. The terms“comprising”, “including” and “having” are intended to be inclusive andmean that there may be additional elements other than the listedelements.

As various changes could be made in the above constructions, products,and methods without departing from the scope of the invention, it isintended that all matter contained in the above description and shown inthe accompanying drawings shall be interpreted as illustrative and notin a limiting sense.

What is claimed is:
 1. An angiosome-based perfusion monitoring systemfor peripheral artery disease, the monitoring system comprising: acompression device sized and shaped for placement on a limb of asubject, the compression device including: a plurality of pressurizablebladders configured to exert a suitable compressive force on the limb ofthe subject when pressurized to substantially occlude blood flow intoskin capillary beds adjacent to the plurality of pressurizable bladders,and a plurality of spaced apart perfusion sensors, wherein each sensorof the plurality of perfusion sensors is located generally adjacent atleast one bladder of the plurality of pressurizable bladders, eachperfusion sensor configured to detect a perfusion parameter of skincapillary beds adjacent the perfusion sensor for quantifying skincapillary bed perfusion and generate a signal indicative of theperfusion parameter, wherein at least one sensor of the plurality ofperfusion sensors is a first-angiosome sensor for detecting theperfusion parameter of a skin capillary bed in a first angiosome of thelimb and at least one sensor of the plurality of perfusion sensors is asecond-angiosome sensor for detecting the perfusion parameter of a skincapillary bed in a second angiosome of the limb that is different fromthe first angiosome, the first-angiosome sensor located generallyadjacent a first bladder of the plurality of pressurizable bladders andthe second-angiosome sensor located generally adjacent a second bladderof the plurality of pressurizable bladders that is different from thefirst bladder.
 2. The monitoring system of claim 1, wherein thefirst-angiosome sensor comprises a plurality of first-angiosome sensors,and wherein the second-angiosome sensor comprises a plurality ofsecond-angiosome sensors.
 3. The monitoring system of claim 2, whereinthe first-angiosome sensors are arranged in a first row extending acrossthe first bladder, and wherein the second-angiosome sensors are arrangedin a second row, different from the first row, extending across thesecond bladder.
 4. The monitoring system of claim 3, wherein the firstand second rows are spaced apart along a length of the compressiondevice.
 5. The monitoring system of claim 2, wherein the first-angiosomesensors and the second-angiosome sensors are arranged in a same rowextending across the first bladder and the second bladder.
 6. Themonitoring system of claim 1, wherein the plurality of pressurizablebladders are spaced apart along a length of the compression device, andwherein the compression device is sized and shaped for placement on aleg of the subject.
 7. The monitoring system of claim 1, wherein theperfusion sensors comprise pulse oximetry sensors.
 8. The monitoringsystem of claim 1, in combination with a control device, the controldevice comprising: a source of pressurized fluid for introducing intothe compression device that is placed on the limb of the subject; and acontrol circuit configured to: pressurize the first bladder when thecompression device is placed on the limb of the subject to substantiallyocclude blood perfusion in skin capillary beds adjacent to the firstbladder, and depressurize the first bladder at a first controlled rateafter pressurizing the first bladder, pressurize the second bladder whenthe compression device is placed on the limb of the subject tosubstantially occlude blood perfusion in skin capillary beds adjacent tothe second bladder, and depressurize the second bladder at a secondcontrolled rate after pressurizing the second bladder, receive separatesensor signals from the first-angiosome sensor and the second-angiosomesensor during respective depressurization of the first bladder and thesecond bladder, wherein the sensor signals are indicative of perfusionparameters of skin capillary beds adjacent the first-angiosome sensorand the second-angiosome sensor for quantifying skin capillary bedperfusion, map sensor signals from the first-angiosome sensor to atleast one of the first angiosome or a first artery of the limb, mapsensor signals from the second-angiosome sensor to at least one of thesecond angiosome or a second artery of the limb different from the firstartery of the limb, and determine, for each perfusion sensor, whetherthe received sensor signals are indicative of peripheral artery disease.9. The monitoring system of claim 8, wherein each of the sensors isconfigured to send an identifier signal to the control deviceidentifying the angiosome or location on the compression devicecorresponding to the sensor, wherein the control device is configured toreceive each identifier signal and determine the location of the sensorbased on the sensor identifier.
 10. The monitoring system of claim 8,wherein the control device is configured to selectively pressurize thefirst bladder and the second bladder.
 11. The monitoring system of claim8, wherein the first controlled rate and the second controlled rate arethe same.
 12. The monitoring system of claim 8, wherein the firstcontrolled rate and the second controlled rate are different.
 13. Themonitoring system of claim 1, further comprising a third-angiosomesensor for detecting the perfusion parameter of a skin capillary bed ina third angiosome of the limb, the third-angiosome sensor locatedgenerally adjacent one of the first bladder or the second bladder. 14.An angiosome-based perfusion monitoring system for peripheral arterydisease, the monitoring system comprising: a control device including: asource of pressurized fluid for introducing into a compression devicethat is placed on a limb of a subject; and a control circuit configuredto: pressurize a first bladder of a plurality of pressurizable bladdersof a compression device when the compression device is placed on a limbof a subject to substantially occlude blood perfusion in skin capillarybeds adjacent to the first bladder, and depressurize the first bladderat a first controlled rate after pressurizing the first bladder,pressurize a second bladder of the plurality of pressurizable bladderswhen the compression device is placed on the limb of the subject tosubstantially occlude blood perfusion in skin capillary beds adjacent tothe second bladder, the second bladder being different from the firstbladder, and depressurize the second bladder at a second controlled rateafter pressurizing the second bladder, receive separate sensor signalsfrom a plurality of perfusion sensors of the compression device duringrespective depressurization of the first bladder and the second bladder,wherein each sensor of the plurality of perfusion sensors is locatedgenerally adjacent at least one bladder of the plurality ofpressurizable bladders, and wherein the sensor signals are indicative ofperfusion parameters of skin capillary beds adjacent the perfusionsensors for quantifying skin capillary bed perfusion, map sensor signalsfrom a first sensor of the plurality of perfusion sensors to at leastone of a first angiosome or a first artery of the limb, the first sensorlocated generally adjacent the first bladder, map sensor signals from asecond sensor of the plurality of perfusion sensors to at least one of asecond angiosome or a second artery of the limb, the second sensorlocated generally adjacent the second bladder, wherein the secondangiosome and second artery are different from the first angiosome andthe first artery, respectively, and determine, for each perfusionsensor, whether the received sensor signals are indicative of peripheralartery disease.
 15. The monitoring system of claim 14, wherein thecontrol device is configured to determine at least one of: adequateperfusion, no flow, baseline flow, skin perfusion pressure value, andreturn of microcirculation based on the received sensor signals.
 16. Themonitoring system of claim 15, wherein the control device is configuredto determine the skin perfusion pressure value based on the receivedsensor signals and compare the skin perfusion pressure value to athreshold value to determine whether the received sensor signals areindicative of peripheral artery disease.
 17. The monitoring system ofclaim 15, wherein the control device is configured to determine thebaseline flow and the return of microcirculation based on the receivedsensor signals and determine a time elapsed between the baseline flowand the return of microcirculation to determine whether the receivedsensor signals are indicative of peripheral artery disease.
 18. Themonitoring system of claim 14, wherein the control device comprises auser interface display, wherein the control circuit is configured togenerate a graphical rendering of the limb and identify on the graphicalrendering the location of a determined peripheral artery disease. 19.The monitoring system of claim 14, wherein the control device isconfigured to selectively pressurize the first bladder and the secondbladder.
 20. A method of monitoring for peripheral artery disease, themethod comprising: pressurizing a first bladder of a plurality ofpressurizable bladders of a compression device that is placed on a limbof a wearer so as to substantially occlude blood perfusion to skincapillary beds adjacent the first bladder; depressurizing the firstbladder at a first controlled rate after pressurizing the first bladder;pressurizing a second bladder of the plurality of pressurizable bladdersof the compression device that is placed on the limb of the wearer so asto substantially occlude blood perfusion to skin capillary beds adjacentthe second bladder, the second bladder being different from the firstbladder; depressurizing the second bladder at a second controlled rateafter pressurizing the second bladder; detecting, during thedepressurizing of the first bladder and using a first perfusion sensorof the compression device, a perfusion parameter of a skin capillary bedlocated in a first angiosome of the limb, the first perfusion sensorbeing located generally adjacent the first bladder; generating a firstsensor signal indicative of the perfusion parameter detected by thefirst perfusion sensor; detecting, during the depressurizing of thesecond bladder and using a second perfusion sensor of the compressiondevice, a perfusion parameter of a skin capillary bed located in asecond angiosome of the limb that is different from the first angiosomeof the limb, the second perfusion sensor being located generallyadjacent the second bladder; generating a second sensor signalindicative of the perfusion parameter detected by the second perfusionsensor; receiving, by a control circuit, the first and second sensorsignals; mapping, by the control circuit, the first sensor signal to atleast one of the first angiosome and a first artery associated with thefirst angiosome; mapping, by the control circuit, the second sensorsignal at least one of the second angiosome and a second arteryassociated with the second angiosome; and determining, by the controlcircuit, whether the first and second sensor signals are indicative ofperipheral artery disease.
 21. The method of claim 20, furthercomprising determining, by the control circuit, at least one of:adequate perfusion, no flow, baseline flow, skin perfusion pressurevalue, and return of microcirculation based on the received sensorsignals.
 22. The method of claim 21, further comprising determining, bythe control circuit, the skin perfusion pressure value based on thereceived sensor signals and comparing the skin perfusion pressure valueto a threshold value to determine whether the received sensor signalsare indicative of peripheral artery disease.
 23. The method of claim 21,further comprising determining, by the control circuit, the baselineflow and the return of microcirculation based on the received sensorsignals, and calculating, by the control circuit, a time elapsed betweenthe baseline flow and the return of microcirculation for use indetermining whether the received sensor signals are indicative ofperipheral artery disease.
 24. The method of claim 21, furthercomprising generating, by the control circuit, a graphical rendering ofthe limb, and identifying, by the control circuit, the location of thedetermined peripheral artery disease on the graphical rendering.
 25. Themethod of claim 20, further comprising detecting, during depressurizingone of the first bladder or the second bladder and using a thirdperfusion sensor of the compression device, a perfusion parameter of askin capillary bed located in a third angiosome of the limb that isdifferent from the first angiosome and the second angiosome, the thirdperfusion sensor being located generally adjacent one of the firstbladder or the second bladder.
 26. The method of claim 20, wherein thefirst controlled rate and the second controlled rate are the same. 27.The method of claim 20, wherein the first controlled rate and the secondcontrolled rate are different.